General thread on functional disorders in Sweden

[The ME Inquiry Report]

Unfortunately, it feels like we need a separate thread on functional disorders in Sweden now.

I take my starting point in a podcast that one of Sweden's medical associations (Svensk förening för allmänmedicin, SFAM) produces and which relatively recently released an episode on functional symptoms. There is a doctor called Carl Sjöström who is one of the driving forces in this issue in Sweden and who in this podcast promotes both Per Fink's TERM model and Recovery Norway. He talks in great detail about how doctors should approach patients using different techniques to gain their trust in order to get them to change the explanatory model for their illness.

The podcast is in Swedish [link here] but I have written two posts about the content and put auto translated links here:
On successfully manipulating patients (1)
On successfully manipulating patients (2)

 

[Hoopoe]

So the first step is to find out what the patient's explanatory model looks like, and there you also need to broaden that to hear what the surrounding people's explanatory model looks like? What do relatives think? And it has been shown that we, especially doctors, rush through that very quickly. We can ask that question, but then we quickly move on and try to explain what we think is wrong. Most people should probably stay with that a little longer. Really explore how that explanatory model has arisen. What are the consequences of that explanatory model? How has it affected the patient's behavior and coping strategies?

My explanatory model was approximately: there is some undiagnosed illness that makes it impossible to live a normal life, and to treat it, I must obtain an accurate diagnosis. Other people seem to have difficulty understanding me and tend to give poor advice and ineffective treatments.

This model arose precisely because it was considered common sense that unexplained symptoms were curable and explainable by a psychological framework, and were also not serious. That caused various problems, in particular a lack of urgency and an unwillingness to accept that I did not have control over the situation, and a deep sense of being misunderstood and being harmed by that misunderstanding.

Also, this sense of being misunderstood then leads to trying to help doctors better understand what I'm experiencing by going tinto detail and trying to think of everything that might be just a little bit abnormal. More information must be better, right? This behaviour is probably interpreted by doctors as somatizing or functional symptoms. But it's just a consequence of wanting to be understood and wanting a diagnosis that is true.

I suspect that the patients treated by Dr Sjöström who don't get better end up with similar views.

 

[The ME Inquiry Report]

I suspect that the patients treated by Dr Sjöström who don't get better end up with similar views.

Unfortunately, I recognize a lot in what you write. I also think that people who have been gaslighted and tormented by health care for a long time are very receptive to the kind and understanding care that Sjöström describes that doctors should use to "convert" their patients.

 

[Utsikt]

The hubris is off the charts.

They are essentially advocating for healthcare practitioners to become better gaslighters.

I’m dealing with something similar in Norway with three different medical workers that try to tell me, and more importantly my family, that I will get better if I dare to try to do a little more. My family is eating it up, because why wouldn’t they want there to be a solution?

When I ask for explanations I get some vague handwaving about allostasis, because they’ve already said that they don’t support the deconditioning model of ME/CFS. They don’t seem to understand that the allostatic model assumes that a prolonged lack of stimuli is the cause of ME/CFS.

 

[Sean]

He talks in great detail about how doctors should approach patients using different techniques to gain their trust in order to get them to change the explanatory model for their illness.

i.e. How to more effectively lie to patients, entirely to avoid the liar facing up to the stark appalling fact that they actually have no explanation and no treatment to offer.

This should be a formal crime, and a very serious one.

 

[The ME Inquiry Report]

At this very moment, a PhD program is underway at the Faculty of Medicine at Linköping University called "Persistent Symptoms: Mind-Body perspectives". Several familiar BPS-lobby names are in the list of lecturers both Swedish and international.

List of speakers and link to program and curriculum can be found in my blog post.

Autotranslated link: Persistent Symptoms: Mind-Body perspectives